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Why doctors leave their posts – problem-solving irregularities in the health sector with healthcare workers in Bangladesh

Mushtaq Khan's picture

It’s not often you get together the very people working on the frontline to sit down together and discuss why and how irregular practices occur in their sector – and what can be done about them. But that’s just what we did with a group of frontline health workers at a workshop in Bangladesh’s capital Dhaka in December 2017. We wanted to understand why corrupt and irregular practices occur in the health sector - what are the underlying incentives and processes? And what are some feasible and impactful ways to change these practices?

Many developing countries, including the three where our research consortium, the Anti-Corruption Evidence research consortium is working, Bangladesh, Nigeria and Tanzania, struggle to provide free or low-cost healthcare to all their citizens. Instead, citizens are often forced to buy services from the private sector at higher fees or worse, approach untrained or traditional healers. There is agreement in the literature that a large proportion of these inefficiencies occur due to corrupt practices (though there’s an active debate about whether using the c-word is helpful in this debate, which is why we talked about ‘irregularities’ during this workshop). Many of these practices are related to the way societies in developing countries are organized around patron-client relations, where tax resources are insufficient, and resources, jobs and promotions require lobbying powerful politicians.

Weekly wire: The global forum

Roxanne Bauer's picture

These are some of the views and reports relevant to our readers that caught our attention this week.

The State of Social 2018 Report: Your Guide to Latest Social Media Marketing Research [New Data]
What’s in store for the social media industry in 2018? The way consumers use social media channels is constantly evolving and as marketers and entrepreneurs, we need to adapt to these changes. To better understand these changes, plus what’s ahead for 2018 and beyond we teamed up with Social Media Week to collect data from over 1,700 marketers and create the State of Social Media 2018 report. The report shows us how marketers, from businesses of all sizes, are approaching social media marketing.
World Bank’s ‘Global Dataset’ Offers New Way for Comparing Countries’ Educational Performance
Market Brief Ed Week
For years, efforts to explore and compare the educational performance of impoverished countries–and by implication, their economic potential–have been stymied by a lack of useful data. An ambitious new analysis by the World Bank aims to change that. A “global dataset” unveiled by the international development organization uses statistical methods to put the results of much-publicized international tests like the PISA and TIMSS–which many poor nations do not take part in–on a comparable scale as regional exams commonly used by developing countries. The result is a new method for comparing the test performance of rich and poor nations that World Bank researchers say hasn’t been accomplished before.

Taking the lead on green growth

Suvojit Chattopadhyay's picture

Bangladesh has what it takes to influence this global movement

Manik, a solar pump operator for Nusra works near the solar panels in Rohertek, Bangladesh
Solar panels in Rohertek, Bangladesh, Oct 2016

Bangladesh has made remarkable progress over the past two decades, lifting millions out of poverty and sustaining expanding levels of economic growth.

It has achieved this in spite of major internal and external challenges — global economic downturns, natural disasters, and periods of political uncertainty that have tested the resolve of the Bangladesh economy.

In spite of this and efforts in climate change adaptation, Bangladesh still remains one of the most vulnerable countries to climate change according to the Global Climate Risk Index 2015.

This crisis has sparked an urgent response from the government. The government of Bangladesh is a leader amongst Less Developed Countries (LDCs) in enacting policies to tackle the risks emerging from climate change, as well as in negotiating on behalf of other vulnerable countries to finance both climate change adaptation and mitigation activities.

Bangladesh played a leading role in helping set up the global Green Climate Fund (GCF) with an ambitious agenda to mobilise $100 billion per year from rich countries by 2020 to finance climate change initiatives in developing countries.

Domestically, much more remains to be done towards climate change mitigation. There are multiple sector-specific and cross-cutting policies in place. However, a comprehensive set strategy in support of green growth is yet to be formulated.

Using behavioral sciences to teach fitness: A (sometimes unwilling) student’s perspective

Julie Perng's picture

 U.S. Air Force photo/Airman 1st Class Nathan L. MaysonetEvery Monday and Wednesday afternoon, sometime between two and three, the email arrives. There’s no content, only a subject line inviting me to tomorrow morning’s cycling class.

I’m not one to enjoy spinning. But thanks to Arben Gjino, the originator of these emails, I participate in the cruel exercise approximately 150% more than I would have in an Arben-less world. So how did this Albanian-born, former volleyball Coach get me to ride time and time again alongside a dedicated group of early morning spinning enthusiasts?

Over time, I have pieced together his secret. What helps Arben – and his students – is the utilization of concepts from psychology. In particular, he uses concepts such as being non-discriminatory, salient nudges, making the classes fun and personal, and role-modeling. As a member of the World Bank’s behavioral sciences team, which applies psychology to international development projects, I especially appreciate the use of these techniques being used on – and for - me.

Lessons from the field: How the World Bank-Annenberg Summer Institute can help propel your career

Umou Al-Bazzaz's picture

Each summer, the World Bank collaborates with the Annenberg School for Communication at the University of Pennsylvania and the Annenberg School for Communication and Journalism at the University of Southern California to offer the executive education course on Reform Communication: Leadership, Strategy and Stakeholder Alignment.
Apply today!  The first early-bird deadline is February 23.

During the 10-day program, participants learn the most recent advances in communication and proven techniques in reform implementation, including interpreting and using political economy analyses; crafting multi-stakeholder collaboration, coalition and network building strategies and tactics; providing communication skills that support the implementation of reforms; and developing communication metrics and applying monitoring and evaluation frameworks relevant to reforms.
Participants also connect with a global network of development professionals working on initiatives in the public, private and non-profit sectors.
But you don’t have to take our word for it. Here is some of the feedback we have received: 

#1 from 2017: Future jobs for youth in agriculture and food systems: Learning from our backyard in DC

Iftikhar Mostafa's picture
Our Top Ten blog posts by readership in 2017. This post was originally posted on March 14, 2017.
When we think of agriculture and food, we think of a farmer working in a rural area producing food for consumption and selling some surplus.  With growing urbanization and increasing demand for food, food system has moved away from just agricultural production. It involves aggregating, value addition, processing, logistics, food preparation, restaurants and other related services.  Many enterprises from small to large are part of the enterprise ecosystem.  The potential for new jobs for youth who start and are also employed by their enterprises is significant. The Africa Agriculture Innovation Network (AAIN) has developed a business agenda targeting establishment of at least 108 incubators in 54 African countries in the next 5 years focusing on youth and women among other actors. At least 600,000 jobs will be created and 100,000 start-ups and SMEs produced through incubation and 60,000 students exposed to learn as you earn model and mentored to start new businesses.

In recent past, there have been many innovations in areas of technology, extension, ICT, education, and incubation leading to new generation of enterprises and enterprise clusters resulting in the creation of good quality and new jobs in agriculture and food systems. A key challenge in the future is how we create more and better jobs in the agriculture and food system value chain. One of the major requirements for creating more jobs is a radical change in the way youth are taught agriculture and entrepreneurship. The skills required for a modern agriculture and food system are of a higher order and need to be upgraded significantly.

As part of the 2017 Global Learning Forum more than 250 staff in the Agriculture Global Practice from around the world are learning how Agriculture and Food Systems are going to look like in future. The group participants visited the Urban Food Hubs Program being managed by the University of the District of Columbia (UDC). The Urban Food Hubs focus on four components: food production, food preparation, food distribution, and waste and water recovery.

#2 from 2017: Doing good against all odds – remembering the forgotten

Leszek J. Sibilski's picture
Our Top Ten blog posts by readership in 2017. This post was originally posted on February 7, 2017.

The opportunity for doing mischief is found a hundred times a day, and of doing good once in a year.
 - Voltaire
Every November 1st, Poland observes All Saints Day or as some call it, the Day of the Deceased. In the middle of the Polish Golden Autumn there is a day when all Poles meet each other at the cemetery. Flowers and candles are lit to honor loved ones who are no longer with us. Most Polish cemeteries are very pristine and well cared for. For me this is a day of national truce and solidarity intertwined with the Roman-Catholic tradition. All Saints Day is celebrated in other countries, but the poignancy and mobility in Poland has no match. The day before and the day after, millions of Poles patiently travel for hours in never-ending traffic jams.
I am not always able to attend All Saints Day in my native Poland, but there are always flowers, wreaths, and candles, exceeding the number of my living distant relatives at the grave of my parents. And then there are the invisible friendly hands that clean my family's tomb a few weeks later, before the beginning of winter. The culmination of this holiday is an outdoor mass before dusk, which basically occurs at every cemetery. I must admit that for as long as I can remember; I have always tried to skip the mass service saturated with the presence of thousands of worshipers for the sake of long walks in the marvelous fall festival of lights a few hours later where the cemeteries are almost deserted. Imagine, walking in darkness on the fallen and golden dry leaves amongst the orange glow of thousands of lit candles that blend with a scent of burning wax and the array of thousands of flowers. Surrounded by people who act most courteously towards each other, and then there is the humbling moment of realizing again that death is a destiny for each of us. All of this is accompanied by solemn tranquility and feelings of nostalgia.

#3 from 2017: Bringing technology to the doorsteps of India’s smallholder farmers for climate resilience

Priti Kumar's picture

Our Top Ten blog posts by readership in 2017. This post was originally posted on September 7, 2017.

Photo by Nitish Kumar Singh“I walk through three farm plots of my fellow farmers every day to examine the crop growth and occurrences of pest attacks or crop failure. I send photo alerts via my smart phone to Cropin, which sends an advisory within a few minutes to remedy the problem, said Pratima Devi, a climate smart village resource professional in Manichak village in the Barachatti block of Gaya district in Bihar, India.
Cropin Technology Solutions Pvt. Ltd, a private software and mobile apps company, has developed digital applications to advise farmers on ways to achieve optimal harvests, depending on weather conditions, soil and other indicators. In less than a month, Pratima Devi completes a visit to all the farm plots in her village that are registered to get agro-advisories. “Women farmers appreciate my efforts and have started trusting my advice because they see a positive difference on their farms,” she adds.

Ramchandra Prasad Verma has the status of a master trainer of climate-smart village resource professionals in the same Barachatti block. He succinctly explains how data on weather parameters, such as rainfall, temperature and humidity, provided by the Automatic Weather Station (AWS), which was installed by another private Indian company, Skymet, helps farmers make smarter decisions in the village. “When the AWS shows temperatures of 35-40 degree Centigrade, farmers will wait for cooler temperatures before transplanting paddy mat nurseries into the field. Otherwise, there is a fear of losing crops in high temperatures”, said Verma. Earlier farmers relied on traditional wisdom alone, but now digital information can help them make faster and better decisions on the times of sowing and harvesting.

When Verma was a village resource professional, he had raised the maximum number of alerts in Bihar and received many advisories from Cropin on sowing, soil health, seed treatment, and weather forecasts that benefitted farmers. Over time, he developed skills to interpret technical advisories, train farmers to apply information on their fields, and interact with Cropin and Skymet professionals, which earned him the status of a master trainer.

#4 from 2017: Review of Doughnut Economics – a new book you will need to know about

Duncan Green's picture Top Ten blog posts by readership in 2017. This post was originally posted on April 24, 2017.

My Exfam colleague Kate Raworth’s book Doughnut Economics is launched today, and I think it’s going to be big. Not sure just how big, or whether I agree with George Monbiot’s superbly OTT plug comparing it to Keynes’s General Theory. It’s really hard to tell, as a non-economist, just how paradigm-changing it will be, but I loved it, and I want everyone to read it.

Down to business – what does it say? The subtitle, ‘Seven Ways to Think Like a 21st Century Economist’, sets out the intention: the book identifies 7 major flaws in traditional economic thinking, and a chapter on each on how to fix them. The starting point is drawings – working with Kate was fun, because whereas I think almost entirely in words, she has a highly visual imagination – she was always messing around with mind maps and doodles. And she’s onto something, because it’s the diagrams that act as visual frames, shaping the way we understand the world and absorb/reject new ideas and fresh evidence. Think of the way every economist you know starts drawing supply and demand curves at the slightest encouragement.Her main target is GDP (the standard measure of national economic output), and its assumptions – an open systems approach to economics that ignores planetary boundaries as it promotes economic growth. Her breakthrough moment while at Oxfam was coming up with ‘the doughnut’ – two concentric rings representing the planetary ceiling and minimum standards for all human beings. The ‘safe and just space’ between the two rings is where our species needs to be if it wants to make poverty history without destroying the planet.

When Kate came up with the doughnut in a highly influential 2012 paper for Oxfam, my non-visual mind failed to grasp its full value. After all, wasn’t this just a restatement of the idea of sustainable development? But it went viral, especially at the UN, because it allowed activists and policy makers to visualize both the threats and how they were trying to overcome them.

#5 from 2017: The role of social media in development

Rosie Parkyn's picture
Our Top Ten blog posts by readership in 2017. This post was originally posted on May 1, 2017.
Why should development organisations care about social media? Rosie Parkyn looks at social media’s potential to enhance development outcomes in the Global South and how this stacks up against the evidence.  
At BBC Media Action, we take our content to people wherever they are, be that a refugee reception centre in Lebanona homestead in rural Ethiopia or their Facebook feed. Our work as a media organisation makes the biggest difference when we succeed in getting people talking, whether face-to-face or across virtual networks. Social media enables such discussion, broadening it beyond geographically defined communities and existing editorial agendas, and at a scale hitherto unimaginable.
As a development organisation that predominantly produces mass media outputs, social platforms allow us to see how people respond to our content and debate the issues we raise in our programmes. We can observe and interact with audiences in a way that isn’t possible with legacy media like newspapers and TV.
It’s true that many of our most important audiences in the Global South are yet to gain access to social media. Nonetheless, its role and influence within the information ecosystems we work in will only grow and its ability to support positive development outcomes demands exploration.